Social injustice and public health in America
By Barry S. Levy and Victor W. Sidel
Although there has been much progress in the United States toward social justice and improved health for racial and ethnic minorities in the 50 years since the 1963 March on Washington and Dr. Martin Luther King’s “I Have a Dream” speech, much social injustice persists in this country — with profound adverse consequences for the public’s health.
Social injustice is manifested in a variety of ways. For example, among African Americans and other people of color, although life expectancy has increased and infant mortality has decreased during the past 50 years, wide gaps remain in these parameters between people of color and whites in the United States. While the rich get richer, the poor (disproportionately including racial and ethnic minorities) get poorer. The ongoing weakening of the social safety net — reflected in cutbacks in the food stamp program and other programs that serve those who have less — worsens the health and well-being of those who are most disadvantaged.
Public health has been defined as “what we, as a society, do collectively to assure the conditions in which people can be healthy.” These conditions include protection of human rights, such as access to quality medical care and preventive services, safe and healthful living and working environments, nutritious and safe food and clean water, and quality education and employment opportunities, as well as participation in the political decisions that affect people’s lives. Social injustice accounts for many of the barriers that remain in assuring these conditions for people to be healthy.
We believe that addressing social injustice and its many health consequences — and making Dr. King’s dream a reality — will require popular and political will and collective action based on a four-pronged approach: protecting human rights, supporting community-based initiatives, promoting sustainable human development, and strengthening the social safety net for those who are most vulnerable.
Protecting human rights: Human rights — globally recognized standards and norms that apply to all people — consist of both civil and political rights, such as the right to liberty and the right to vote, and economic, social, and cultural rights, including rights to education, to work, and to the highest attainable standard of health. Governments have obligations to assure that these rights are guaranteed, especially for racial and ethnic minorities, poor people, and other marginalized populations. Human rights standards prohibit discrimination on the basis of racial or ethnic group, socioeconomic status, and other factors.
Supporting community-based initiatives: Social injustice can also be effectively addressed by strengthening communities and the roles of individual people within communities — not only communities based on geographic location, but also other forms of social networks. Communities provide various types of support in identifying and reducing social injustice, promote participation and engagement of individuals, and facilitate development of groups and organizations to advocate for policies and to take actions to address social injustice. Engaged and mobilized communities are essential to addressing social injustice and its adverse health consequences.
Promoting sustainable human development: Both in the United States and elsewhere, addressing social injustice requires a commitment to sustainable human development, which in turn requires a combination of measures to promote economic growth and measures to promote social justice and reduce inequalities. Equity needs to be made an economic priority with government measures to ensure access to education, to create jobs, and to establish a minimum wage that enables workers and their families to meet their basic needs. Sustainable human development includes ways to ensure that social and physical environments are promoted and protected for current and future generations.
Strengthening the social safety net: Those who are poor and vulnerable depend on social safety-net programs and services that provide income support, facilitate access to health care and education, provide job training and employment opportunities, and serve other functions. In sum, they counteract some of the adverse consequences of social injustice. In recent years in the United States, many of these programs have suffered major cutbacks in financial and political support. This trend needs to be reversed.
As we mark the 50th anniversary of Dr. King’s speech, we as a society need to recommit to the realization of Dr. King’s dream and the achievement of social justice for all people. We all share a common interest in eliminating social injustice. As Dr. King said, “Injustice anywhere is a threat to justice everywhere.”
Dr. Barry S. Levy and Dr. Victor W. Sidel are co-editors of the second edition of Social Injustice and Public Health, which was recently published by Oxford University Press. They are both past presidents of the American Public Health Association. Dr. Levy is an Adjunct Professor of Public Health at Tufts University School of Medicine. Dr. Sidel is Distinguished University Professor of Social Medicine Emeritus at Montefiore Medical Center and Albert Einstein Medical College and an Adjunct Professor of Public Health at Weill Cornell Medical College.